Left-side Catamenial Pneumothorax with Endometrial Tissue on the Visceral Pleura

Satoshi Suzuki, Koji Yasuda, Yuji Matsumura, Takashi Kondo
In: General Thoracic and Cardiovascular Surgery · 2006 · vol. 54(5) , pp. 225–227 · doi:10.1007/bf03397156 · PMID:16764314 · W72990944
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This case report describes a left-side catamenial pneumothorax in a woman where endometrial tissue was found on the visceral pleura, potentially causing cyclic pleural erosion and air leakage.

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This paper reports a rare case of left-sided catamenial pneumothorax in a 41-year-old woman who had three episodes occurring with menstruation. Imaging confirmed a left pneumothorax but did not show bullae or other anomalies; video-assisted thoracoscopic surgery found tiny diaphragmatic holes and small brown spots on the visceral pleura, and histology demonstrated endometrial tissue on the visceral pleura with disrupted pleural elastic fibers. The authors interpret the findings as cyclic erosion of the visceral pleura by implanted endometrial tissue leading to air leakage, alongside the established concept of air entering via diaphragmatic fenestration. This paper is centrally about endometriosis — specifically endometrial tissue on the visceral pleura causing catamenial pneumothorax, a manifestation within endometriosis-related thoracic involvement.

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Abstract

We present here a rare case of left-side catamenial pneumothorax, in which endometrial tissue pleura was found on the visceral pleura histologically. A chest roentogenogram confirmed the left pneumothorax, but did not reveal bullae or any associated anomalies, in a 41-year-old woman with three documented episodes of left-side pneumothorax occurring every menstruation. Video-assisted thoracoscopic surgery revealed not only tiny holes in the diaphragm, but also a scattered small brown spots on the visceral pleura. Histological examination of the lung sections revealed the existence of endometrial tissue on the visceral pleura with disrupted pleural elastic fibers. Our case suggests that cyclic erosion of the visceral pleura by the implanted endometrial tissue caused air leakage from the lung, in addition to the most accepted concept that air is aspirated into the thoracic cavity via the abdomen through the acquired fenestration of the diaphragm.
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Abstract

We present here a rare case of left-side catamenial pneumothorax, in which endometrial tissue pleura was found on the visceral pleura histologically. A chest roentogenogram confirmed the left pneumothorax, but did not reveal bullae or any associated anomalies, in a 41-year-old woman with three documented episodes of left-side pneumothorax occurring every menstruation. Video-assisted thoracoscopic surgery revealed not only tiny holes in the diaphragm, but also a scattered small brown spots on the visceral pleura. Histological examination of the lung sections revealed the existence of endometrial tissue on the visceral pleura with disrupted pleural elastic fibers. Our case suggests that cyclic erosion of the visceral pleura by the implanted endometrial tissue caused air leakage from the lung, in addition to the most accepted concept that air is aspirated into the thoracic cavity via the abdomen through the acquired fenestration of the diaphragm. Similar content being viewed by others

References

Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: A prospective study. Chest 2003; 124: 1004–8s. Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: Retrospective study of surgical treatment. Ann Thorac Surg 2003; 75: 378–81. Korom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, et al. Catamenial pneumothorax revisited: Clinical approach and systemic review of the literature. J Thorac Cardiovasc Surg 2004; 128: 502–8. Sakamoto K, Ohmori T, Takei H. Catamenial pneumothorax caused by endometriosis in the visceral pleura. Ann Thorac Surg 2003; 76: 290–1. Maurer ER, Schaal JA, Mendez FL Jr. Chronic recurring spontaneous pneumothorax due to endometriosis of the diaphragm. J Am Med Assoc 1958; 168: 2013–4. Author information Authors and Affiliations Rights and permissions About this article Cite this article Suzuki, S., Yasuda, K., Matsumura, Y. et al. Left-side Catamenial Pneumothorax with Endometrial Tissue on the Visceral Pleura. Jpn J Thorac Caridovasc Surg 54, 225–227 (2006). https://doi.org/10.1007/BF03397156 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/BF03397156

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